Is bed-wetting during pregnancy normal?
Bed-wetting - the definition
Until the age of five, it is normal for children to wet the bed every now and then at night. However, the WHO, the World Health Organization, defines bedwetting as Illness requiring treatmentif the child has reached the age of five and involuntarily wets the bed at night at least twice a month and organic underlying diseases are excluded.
The medical term for this is "enuresis" and describes nocturnal incontinence, i.e. the involuntary urination during sleep.
A distinction is made between primary and secondary enuresis. If the child is always wet and has never been dry for more than six months, this is known as primary enuresis. Secondary enuresis is when the child returns after a period of at least six months of dryness
soaked. The causes of primary and secondary enuresis are usually different.
The causes of enuresis are many and they can be very different.
No fault in upbringing!
While it used to be believed that bed-wetting was the result of a problematic family situation or poor upbringing, we now know that this is not the case with the vast majority of children. Primary enuresis, the most common bladder emptying disorder in children, has in the rarest cases psychological causes - on the other hand, mental disorders can be the result of long-term non-treatment.
Possible causes of primary enuresis include:
- Family disposition
The familial component clearly plays an important role in enuresis. The likelihood of a child suffering from enuresis is 45% if one parent was affected and 77% if both parents became dry late themselves.
- Maturity delay
A common cause is a delay in maturation of nerve structures that are important for emptying the bladder. This is associated with a wake-up disorder of the child. Parents then often have the impression that their child is sleeping extremely deeply and that the child is difficult to wake up.
- Wrong drinking habits
If children drink too little or too much during the day or not evenly throughout the day, this can lead to problems with the bladder and night-time wetting.
- Deficiency of a hormone that is important for the water balance (ADH)
If the child wets larger amounts at night, this can indicate a deficiency of the antidiuretic hormone, which has the task of reducing the amount of urine at night.
- Low bladder capacity
Insufficient bladder capacity can also be the cause of nighttime wetting.
Possible causes of secondary enuresis include:
- Urinary tract infections, diabetes, etc.
- Psychosocial factors such as family or school stress and in very rare cases other diseases.
Numbers and information
In Germany alone there are more than 640,000 children over the age of five who regularly wet their bed at night. Bedwetting is the second most common chronic disease in childhood after asthma.
Around 15% of all bed-wetting children between the ages of 5 and 15 dry out on their own every year - but this also means that 85% of these children will wet their bed for at least another year. Only about 32% of all affected children are even presented to the doctor and receive appropriate treatment. Research shows that 1-3% of all teenagers and adults never get rid of the problem.
Many parents report that their exuding children sleep particularly deeply. Studies have shown, however, that these children do not sleep deeply, but rather have a wake-up problem.
The problems increase with age
The older the affected children or adolescents who are still wet, the more serious the problem.
For one thing, we now know that the older they are, the more often they wet themselves at night: of the 5-year-olds, around 14% wet themselves every day of the week, and 56% have fewer than three wet nights a week. Of 19 year olds, 49% wet daily and only 10% of them have less than three wet nights a week.
On the other hand, we also know that treating children becomes more difficult the older they are.
The World Health Organization defines enuresis as a disease requiring treatment in children from the age of five.
We know that the longer the disease lasts, the more difficult the treatment for enuresis, and we know that there are numerous sensible and successful therapies. It therefore makes sense that children who regularly wet themselves at night at the age of five go to the pediatrician so that they can think about a suitable therapy at an early stage.
The doctor should rule out infections, malformations and other organic underlying diseases in these children and then, if necessary, discuss with the child and the parents whether and which therapy makes sense and from when.
What does the basic diagnosis look like?
Precisely because the causes and thus also the therapy of enuresis can be so different, it is necessary for the doctor to carry out a careful diagnosis. This includes:
- an anamnesis interviewwhich asks, among other things, how long the child has been wetting, whether there are also daily problems, whether someone in the family has or had the same problem;
- a physical examto rule out a malformation or neurological disorder;
- an ultrasound scan the full and empty bladder;
- a urine testto rule out infection;
- the evaluation of a bladder diaryin order to get closer to the causes of enuresis and, if necessary, to track down drinking malpractice
The bladder diary is a log that is kept for 3 to 4 days (this can also be two weekends) and for 14 (consecutive) nights.
It is noted here:
- When does the child get up in the morning?
- When does the child go to bed?
- When does the child go to the toilet?
- When does the child wet?
- How much urine does it pass?
- It is optimal to determine the amount of urine relatively precisely.
- When, how much and what does the child drink?
- Special features such as urge symptoms, holding maneuvers, pressing or stuttering urine stream
- All information about bowel movement
- When does the child have a bowel movement, is it soft, hard, a lot, a little ...
Further examinations are only useful if any abnormalities are noticed during this basic examination.
If, in addition to monosymptomatic enuresis, daytime symptoms such as urgency or incontinence occur, these symptoms should be treated first.
However, if there is monosymptomatic primary enuresis, depending on the cause of the enuresis, in addition to urotherapy according to the current international therapy guidelines of the European Association of Urology [EAU] and the European Society for Pediatric Urology [ESPU]
- drug therapy and the
- Alarm therapy
available and a combination of these above.
Urotherapy consists of various behavioral methods for the treatment of faecal and urinary incontinence as well as for the treatment of enuresis, if this is causally associated with incorrect drinking and toilet behavior.
The processes in the body are explained to the children and parents in a conversation, such as how, what, when and how much should be drunk and also how and how often the child should go to the toilet. In addition, the importance of the bladder diary is explained and how it can be kept correctly.
If there is monosymtomatic primary enuresis, the child has never been dry for more than six months and there are no other bladder diseases or daytime symptoms, and if the child passes too much urine at night, the enuresis occurs more frequently in the family or if no other symptoms are found , then the international therapy guidelines recommend therapy with desmopressin.
The pharmacological agent desmopressin is modeled on the body's own vasopressin. Vasopressin ensures that we produce less urine in the kidneys at night.
The drug is given as a tablet or orodispersible tablet over a period of about three months. The long-term goal of desmopressin therapy is to stimulate the body's own production of vasopressin.
The success of desmopressin therapy depends on whether and how the drug is tapered off. After three months of intake, the structured tapering off begins by slowly lengthening the intake intervals. After this schedule, more than 84% of children remain dry over the long term.
Since desmopressin reduces the excretion of water, nothing should be drunk in the evening after taking the drug. If the child does not adhere to the fluid restriction, there is a risk of overhydration.
The principle of the so-called alarm therapy is based on a learning theory concept in order to strive for a change in behavior.
Alarm therapy requires a wake-up device consisting of a moisture sensor that is attached to underpants, diaper insert or mattress pad and which triggers an alarm with the first drop of urine. This alarm is intended to wake the child and interrupt the micturition reflex. The rest of the bladder emptying should then take place in the toilet.
For alarm therapy, the compliance of the child and parents is necessary to a high degree. Many children do not wake up to the alarm on their own. You must then be fully awakened by your parents immediately after the alarm has sounded and escorted to the toilet. Alert therapy, when used correctly and properly used by the family, has success rates of 40 to 80%.
Alarm therapy does not make sense if the child's nocturnal excretion exceeds the bladder capacity.
In summary, it can be said that older children are also affected by bedwetting much more than most people think. In the rarest of cases, mental problems are the cause of the nocturnal wetting; however, mental problems can be the result of long-term and untreated enuresis.
There are successful and meaningful therapies that are more effective and easier the earlier the child is treated (but not before the age of five).
The doctor can only make a therapy recommendation individually after a detailed diagnosis. For a good diagnosis, the evaluation of a bladder diary is absolutely necessary.
Initiative Dry Night e.V.
Telephone 0700-ENURESIS (0700-36873747)
Created on November 28th, 2011, last changed on November 28th, 2011
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